CAJ | 학술논문

目的：探讨多层螺旋CT灌注成像（ CTP）联合CT门静脉造影（ CTPV）一站式扫描技术的可行性及其在肝硬化诊断、肝功能储备分级、了解侧支循环情况及发现其他并发症中的应用价值。方法根据自愿原则，选取南方医科大学珠江医院2014年1—10月入院且临床拟诊为肝硬化的患者83例。按照纳入与排除标准，最终共纳入74例患者为试验组，按照Child-Pugh分级标准将试验组患者进一步分为Child-Pugh A组（31例）、 Child-Pugh B组（27例）和Child-Pugh C组（16例）。另同期选取临床上需要行上腹部CT增强扫描检查并且肝脏及门静脉系统正常的患者20例为对照组。对所有患者行CTP扫描，分析并比较各组患者肝动脉灌注量（ HAP）、门静脉灌注量（ HPP）、肝总灌注量（THP）、肝脏灌注指数（HPI）及门静脉达峰时间（TTP），分析HAP、 HPP、 THP及HPI与Child-Pugh分级的相关性，选择成像最佳的门静脉期数据进行CTPV重建并分析图像质量。结果 Child-Pugh A组、 Child-Pugh B组、 Child-Pugh C组HPP、 THP低于对照组， HPI高于对照组（P＜0.05）； Child-Pugh C组HAP低于对照组（P＜0.05）； Child-Pugh B组、 Child-Pugh C组HPP低于Child-Pugh A组， HPI高于Child-Pugh A组（P＜0.05）； Child-Pugh C组HAP、 THP低于Child-Pugh A组（ P＜0.05）； Child-Pugh C组HAP、 HPP、 THP低于Child-Pugh B组（ P＜0.05）。 Child -Pugh 分级与 HAP 无直线相关性（ r ＝-0.143， P ＝0.169），与 HPP、 THP 呈负相关（ r＝-0.730、-0.614， P＜0.05），与HPI呈正相关（r＝0.555， P＜0.05）。 Child-Pugh C组门静脉TTP较对照组、Child-Pugh A组、 Child-Pugh B组延迟（ P＜0.05）。试验组与对照组CTPV图像质量比较，差异无统计学意义（ u＝0.526， P＝0.599）。结论多层螺旋CTP联合CTPV一站式扫描技术可同时提供准确的CT灌注参数以及满意的CT血管造影图像，可为肝硬化的诊断、肝功能储备分级、了解门-体侧支循环及发现其他并发症提供更全面的影像学信息。目的：探討多層螺鏇CT灌註成像（ CTP）聯閤CT門靜脈造影（ CTPV）一站式掃描技術的可行性及其在肝硬化診斷、肝功能儲備分級、瞭解側支循環情況及髮現其他併髮癥中的應用價值。方法根據自願原則，選取南方醫科大學珠江醫院2014年1—10月入院且臨床擬診為肝硬化的患者83例。按照納入與排除標準，最終共納入74例患者為試驗組，按照Child-Pugh分級標準將試驗組患者進一步分為Child-Pugh A組（31例）、 Child-Pugh B組（27例）和Child-Pugh C組（16例）。另同期選取臨床上需要行上腹部CT增彊掃描檢查併且肝髒及門靜脈繫統正常的患者20例為對照組。對所有患者行CTP掃描，分析併比較各組患者肝動脈灌註量（ HAP）、門靜脈灌註量（ HPP）、肝總灌註量（THP）、肝髒灌註指數（HPI）及門靜脈達峰時間（TTP），分析HAP、 HPP、 THP及HPI與Child-Pugh分級的相關性，選擇成像最佳的門靜脈期數據進行CTPV重建併分析圖像質量。結果 Child-Pugh A組、 Child-Pugh B組、 Child-Pugh C組HPP、 THP低于對照組， HPI高于對照組（P＜0.05）； Child-Pugh C組HAP低于對照組（P＜0.05）； Child-Pugh B組、 Child-Pugh C組HPP低于Child-Pugh A組， HPI高于Child-Pugh A組（P＜0.05）； Child-Pugh C組HAP、 THP低于Child-Pugh A組（ P＜0.05）； Child-Pugh C組HAP、 HPP、 THP低于Child-Pugh B組（ P＜0.05）。 Child -Pugh 分級與 HAP 無直線相關性（ r ＝-0.143， P ＝0.169），與 HPP、 THP 呈負相關（ r＝-0.730、-0.614， P＜0.05），與HPI呈正相關（r＝0.555， P＜0.05）。 Child-Pugh C組門靜脈TTP較對照組、Child-Pugh A組、 Child-Pugh B組延遲（ P＜0.05）。試驗組與對照組CTPV圖像質量比較，差異無統計學意義（ u＝0.526， P＝0.599）。結論多層螺鏇CTP聯閤CTPV一站式掃描技術可同時提供準確的CT灌註參數以及滿意的CT血管造影圖像，可為肝硬化的診斷、肝功能儲備分級、瞭解門-體側支循環及髮現其他併髮癥提供更全麵的影像學信息。
목적：탐토다층라선CT관주성상（ CTP）연합CT문정맥조영（ CTPV）일참식소묘기술적가행성급기재간경화진단、간공능저비분급、료해측지순배정황급발현기타병발증중적응용개치。방법근거자원원칙，선취남방의과대학주강의원2014년1—10월입원차림상의진위간경화적환자83례。안조납입여배제표준，최종공납입74례환자위시험조，안조Child-Pugh분급표준장시험조환자진일보분위Child-Pugh A조（31례）、 Child-Pugh B조（27례）화Child-Pugh C조（16례）。령동기선취림상상수요행상복부CT증강소묘검사병차간장급문정맥계통정상적환자20례위대조조。대소유환자행CTP소묘，분석병비교각조환자간동맥관주량（ HAP）、문정맥관주량（ HPP）、간총관주량（THP）、간장관주지수（HPI）급문정맥체봉시간（TTP），분석HAP、 HPP、 THP급HPI여Child-Pugh분급적상관성，선택성상최가적문정맥기수거진행CTPV중건병분석도상질량。결과 Child-Pugh A조、 Child-Pugh B조、 Child-Pugh C조HPP、 THP저우대조조， HPI고우대조조（P＜0.05）； Child-Pugh C조HAP저우대조조（P＜0.05）； Child-Pugh B조、 Child-Pugh C조HPP저우Child-Pugh A조， HPI고우Child-Pugh A조（P＜0.05）； Child-Pugh C조HAP、 THP저우Child-Pugh A조（ P＜0.05）； Child-Pugh C조HAP、 HPP、 THP저우Child-Pugh B조（ P＜0.05）。 Child -Pugh 분급여 HAP 무직선상관성（ r ＝-0.143， P ＝0.169），여 HPP、 THP 정부상관（ r＝-0.730、-0.614， P＜0.05），여HPI정정상관（r＝0.555， P＜0.05）。 Child-Pugh C조문정맥TTP교대조조、Child-Pugh A조、 Child-Pugh B조연지（ P＜0.05）。시험조여대조조CTPV도상질량비교，차이무통계학의의（ u＝0.526， P＝0.599）。결론다층라선CTP연합CTPV일참식소묘기술가동시제공준학적CT관주삼수이급만의적CT혈관조영도상，가위간경화적진단、간공능저비분급、료해문-체측지순배급발현기타병발증제공경전면적영상학신식。
Objective To evaluate the feasibility of the one -stop scanning technology combining multi -slice spiral CT perfusion ( CTP) imaging and CT portal venography ( CTPV) and its applicational value in the diagnosis of liver cirrhosis , the grading of liver function reserve , the monitoring of collateral circulation and the detection of other complications .Methods Based on the principle of voluntariness , 83 patients who were preliminarily diagnosed as liver cirrhosis and were admitted into Zhujiang Hospital of Southern Medical University from January to October in 2014 were selected in the study .According to the inclusion and exclusion criteria , 74 patients were enrolled as the trial group .According to the Child-Pugh grading standard , the trial group was further divided into Child -Pugh A group ( n=31 ) and Child-Pugh B group ( n=27 ) and Child -Pugh C group ( n=16 ) . Another 20 patients who were going to receive epigastrium CT enhancement scanning and were normal in liver and portal system were enrolled in the same period as the control group .CTP was conducted on all subjects , by which HAP, HPP, THP, HPI and TTP were analyzed and compared among all the groups .The correlations between Child -Pugh grading and HAP , HPP, THP and HPI were analyzed.The portal venous phase data with the optimal imaging was chosen to reconstruct CT portal venography and analyze the image quality.Results Child-Pugh A group, Child-Pugh B group and Child -Pugh C group were lower ( P<0.05) in HPP and THP and higher (P<0.05) in HPI than control group; Child-Pugh C group was lower (P<0.05) than control group in HAP; Child-Pugh B group and Child-Pugh C group were lower (P<0.05) in HPP and higher (P<0.05) in HPI than Child-Pugh A group; Child-Pugh C group was lower ( P<0.05 ) in HAP and THP than Child -Pugh A group;Child-Pugh C group was lower (P<0.05) than Child-Pugh B group in HAP, HPP and THP.Child-Pugh grading was not correlated (r=-0.143, P=0.169) with HAP, but negatively correlated (r=-0.730, -0.614, P<0.05) with HPP and THP and positively correlated ( r=0.555, P<0.05) with HPI.Compared with control group , Child-Pugh A group and Child-Pugh B group, Child-Pugh C group delayed (P<0.05) in the TTP of portal vein.The trial group and the control group were not significantly different in the quality of CTPV imaging ( u =0.526, P =0.599 ) .Conclusion The one -stop scanning technology combining multi -slice spiral CTP imaging and CTPV could offer accurate parameters of CT perfusion and ideal CT angiography images and provide more complete imaging information of the diagnosis of liver cirrhosis , the grading of liver function reserve , the monitoring of portal -systemic collateral circulation and the detection of other complications .